Skip to main content
SpringerLink
Log in

Contribution of the MDRD equation and of cystatin C for renal function estimates in cancer patients

  • Original Article
  • Published:
Medical Oncology Aims and scope Submit manuscript

Abstract

Background

Serum creatinine (SCr) and Cockcroft-Gault creatinine clearance (CG CrCL) are used to estimate glomerular filtration rate (GFR). Other markers have been proposed including serum cystatin C (cysC) and the Modification of Diet in Renal Disease (MDRD) study equation.

Patients and Methods

We have compared the diagnostic performances of SCr, cysC, CG CrCL, and the MDRD equation in 144 cancer patients. For reference we used either the measured or the predicted carboplatin clearance, which is around the GFR+25 mL/min.

Results

CysC was more sensitive than SCr (70.1% vs 13.4%) but was not very specific (61% for a cut-off =0.95 mL). CysC values were higher in 40 cancer patients vs 40 healthy controls with a similar and normal mean CG CrCL (1.08 vs 0.71 mg/L; p<0.001). CG and the MDRD equations gave similar values for Pearson's coefficient, ROC-plot AUC, and precision, except for patients with poor general status, where the MDRD equation was better (MAPE: 12.4% vs 19.6%, p<0.001; R.: 0.908 vs 0.813).

Conclusions

In cancer patients, cysC is a more sensitive indicator of the glomerular filtration rate than SCr, but its diagnostic performance is lower than for CG CrCL. There may be no advantage in replacing the CG equation by the MDRD equation except for patients with severe malnutrition and/or inflammation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Cockeroft D, Gault M. Prediction of creatinine clearance from serum creatine. Nephron 1976; 16(1):31–41.

    Article  Google Scholar 

  2. Jelliffe RW. Letter; Creatinine clearance: bedside estimate. Ann Intern Med 1973; 79(4):604–605.

    PubMed  CAS  Google Scholar 

  3. Levey AS, et al. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999; 130(6):461–470.

    PubMed  CAS  Google Scholar 

  4. Martin L, et al. Improvement of the Cockcroft-Gault equation for predicting glomerular filtration in cancer patients. Bull Cancer 1998; 85(7):631–636.

    PubMed  CAS  Google Scholar 

  5. Wright JG, et al. Estimation of glomerular filtration rate in cancer patients. Br J Cancer 2001; 84(4):452–459.

    Article  PubMed  CAS  Google Scholar 

  6. Murray PT, Ratain MJ. Estimation of the glomerular filtration rate in cancer patients: a new formula for new drugs. J Clin Oncol 2003; 21(14):2633–2635.

    Article  PubMed  CAS  Google Scholar 

  7. Newman DJ. Cystatin C. Ann Clin Biochem 2002; 39(Pt 2):89–104.

    Article  PubMed  CAS  Google Scholar 

  8. Dharnidharka VR, Kwon C, Stevens G. Serum cystatin C is superior to serum creatinine as a marker of kidney function: a meta-analysis. Am J Kidney Dis 2002; 40(2):221–226.

    Article  PubMed  CAS  Google Scholar 

  9. Stabuc B, Vrhovec L, Stabuc-Silih M, Cizej TE. Improved prediction of decreased creatinine clearance by serum cystatin C: use in cancer patients before and during chemotherapy. Clin Chem 2000; 46(2):193–197.

    PubMed  CAS  Google Scholar 

  10. Al Tonbary YA, Hammad AM, Zaghloul HM, Sayed HE, Abu-Hashem E. Pretreatment cystatin C in children with malignancy: can it predict chemotherapy-induced glomerular filtration rate reduction during the induction phase? J Pediatr Hematol Oncol 2004; 26(6):336–341.

    Article  Google Scholar 

  11. Bardi E, Brook I, Olah AV, Olah E, Kappelmayer J, Kiss C. Cystatin C is a suitable marker of glomerular function in children with cancer. Pediatr Nephrol 2004; 19(10):1145–1147.

    Article  PubMed  Google Scholar 

  12. Hoppe AP, et al. Serum cystatin C is a better marker of topotecan clearance than serum creatinine. Clin Cancer Res 2005; 11(8):3038–3044.

    Article  PubMed  CAS  Google Scholar 

  13. Thomas F, et al. Cystatin C as a new covariate to predict the renal elimination of drugs: application to carboplatin. Clin Pharmacokinetics 2005, in press.

  14. Calvert AH, et al. Carboplatin dosage: prospective evaluation of a simple formula based on renal function. J Clin Oncol 1989; 7(11):1748–1756.

    PubMed  CAS  Google Scholar 

  15. Duffull SB, Robinson BA. Clinical pharmacokinetics and dose optimisation of carboplatin. Clin Pharmacokinet 1997; 33(3):161–183.

    PubMed  CAS  Google Scholar 

  16. Chatelut E, et al. A limited sampling strategy for determining carboplatin AUC and monitoring drug dosage. Eur. J. Cancer 2000; 36(2):264–269.

    Article  PubMed  CAS  Google Scholar 

  17. Rule AD, Larson TS, Bergstralh EJ, Slezak JM, Jacobsen SJ, Cosio FG. Using serum creatinine to estimate glomerular filtration rate: accuracy in good health and in chronic kidney disease. Ann Intern Med 2004; 141(12):929–937.

    PubMed  CAS  Google Scholar 

  18. Wuyts B, et al. Reevaluation of formulas for predicting, creatinine clearance in adults and children, using compensated creatinine methods. Clin Chem 2003; 49(6 Pt 1):1011–1014.

    Article  PubMed  CAS  Google Scholar 

  19. ANAES. Diagnostic de l'insuffisance rénale chez l'adulté. ANAES: recommandation, pour la pratique clinique 2002.

  20. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Kidney Disease Outcome Quality Initiative. Am J Kidney Dis 2002; 39(2 Suppl 2):S1–246.

    Google Scholar 

  21. Seronie-Vivien S, et al. [Improving the interlaboratory variation for creatinine serum, assay]. Ann Biol Clin (Paris) 2004; 62(2):165–175.

    CAS  Google Scholar 

  22. Vervoort G, Willems HL, Wetzels JF. Assessment of glomerular filtration rate in healthy subjects and normoal-buminuric diabetic patients: validity of a new (MDRD) prediction equation. Nephrol Dial Transplant 2002; 17(11):1909–1913.

    Article  PubMed  CAS  Google Scholar 

  23. Kos J, Stabuc B, Cimerman N, Brunner N. Serum cystatin C, a new marker of glomerular filtration rate, is increased during malignant progression. Clin Chem 1998; 44(12):2556–2557.

    PubMed  CAS  Google Scholar 

  24. Nishikawa H, et al. The role of cathepsin B and cystatin C in the mechanisms of invasion by ovarian cancer. Gynecol Oncol 2004; 92(3):881–886.

    Article  PubMed  CAS  Google Scholar 

  25. Strojan P, Svetic B, Smid L, Kos J. Serum cystatin C in patients with head and neck carcinoma. Clin Chim Acta 2004; 344(1–2):155–161.

    Article  PubMed  CAS  Google Scholar 

  26. Mojiminiyi OA, Marouf R, Abdella N, Kortom M, Abdul-Razzak R. Serum concentration of cystatin C is not affected by cellular proliferation in patients with proliferative haematological disorders. Ann Clin biochem 2002; 39(Pt 3):308–310.

    Article  PubMed  CAS  Google Scholar 

  27. Kos J, et al. Cysteine proteinase inhibitors stefin A, stefin B, and cystatin C in sera from patients with colorectal cancer: relation to prognosis. Clin Cancer Res; 2000; 6(2):505–511.

    PubMed  CAS  Google Scholar 

  28. Sokol JP, Schiemann WP. Cystatin C antagonizes transforming growth factor beta signaling in normal and cancer cells. Mol Cancer Res 2004; 2(3):183–195.

    PubMed  CAS  Google Scholar 

  29. Solem M, Rawson C, Lindburg K, Barnes D. Transforming growth factor beta regulates cystatin C in serum-free mouse embryo (SFME) cells. Biochem Biophys Res Commun 1990; 172(2):945–951.

    Article  PubMed  CAS  Google Scholar 

  30. Knight EL, et al. Factors influencing serum cystatin C levels other than renal function and the impact on renal function measurement. Kidney Int 2004; 65(4):1416–1421.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Clinical Biology, Institute Claudius Regaud, 20-24 rue du Pont St' Pierre, 31052, Toulouse Cedex, France

    Sophie Séronie-Vivien, Stéphanie Toullec, Laurence Malard & Valérie Durrand

  2. EA 3035, Institute Claudius Regaud, Toulouse, France

    Fabienne Thomas & Etienne Chatelut

Authors
  1. Sophie Séronie-Vivien
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stéphanie Toullec
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Laurence Malard
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fabienne Thomas
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Valérie Durrand
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Etienne Chatelut
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sophie Séronie-Vivien.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Séronie-Vivien, S., Toullec, S., Malard, L. et al. Contribution of the MDRD equation and of cystatin C for renal function estimates in cancer patients. Med Oncol 23, 63–73 (2006). https://doi.org/10.1385/MO:23:1:63

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1385/MO:23:1:63

Key words

Search

Navigation